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Assessments for Newborn Babies

Each newborn baby is carefully checked at birth for signs of problems or complications. A complete physical assessment will be done that includes every body system. Throughout the hospital stay, doctors, nurses, and other health care providers continually assess the health of the baby, observing for signs of problems or illness. Assessment may include:

Apgar scoring

The Apgar score is one of the first checks of your new baby's health. The Apgar score is assigned in the first few minutes after birth to help identify babies that have difficulty breathing or have a problem that needs further care. The baby is checked at 1 minute and 5 minutes after birth for heart and respiratory rates, muscle tone, reflexes, and color.

Each area can have a score of 0, 1, or 2, with 10 points as the maximum. A total score of 10 means a baby is in the best possible condition. Nearly all babies score between 8 and 10, with 1 or 2 points taken off for blue hands and feet because of immature circulation. If a baby has a difficult time during delivery, this can lower the oxygen levels in the blood, which can lower the Apgar score. Apgar scores of 3 or less often mean a baby needs immediate attention and care.

Sign

Score = 0

Score = 1

Score = 2

Heart rate

Absent

Below 100 per minute

Above 100 per minute

Respiratory effort

Absent

Weak, irregular, or gasping

Good, crying

Muscle tone

Flaccid

Some flexion of arms and legs

Well-flexed, or active movements of extremities

Reflex or irritability

No response

Grimace or weak cry

Good cry

Color

Blue all over, or pale

Body pink, hands and feet blue

Pink all over

Birthweight

A baby's birthweight is an important indicator of health. The average weight for term babies (born between 37 and 41 weeks gestation) is about 7 lbs. (3.2 kg). In general, small babies and very large babies are at greater risk for problems. Babies are weighed daily in the nursery to assess growth, fluid, and nutrition needs. Newborn babies may often lose 5% to 7% of their birthweight. This means that a baby weighing 7 pounds 3 ounces at birth might lose as much as 8 ounces in the first few days. Babies will usually gain this weight back by 2 weeks of age. Premature and sick babies may not begin to gain weight right away.

Most hospitals use the metric system for weighing babies. This chart will help you convert grams to pounds.

Converting grams to pounds and ounces:

1 lb. = 453.59237 grams; 1 oz. = 28.349523 grams; 1000 grams = 1 Kg.

Pounds

Ounces

2

3

4

5

6

7

8

9

0

907

1361

1814

2268

2722

3175

3629

4082

1

936

1389

1843

2296

2750

3203

3657

4111

2

964

1417

1871

2325

2778

3232

3685

4139

3

992

1446

1899

2353

2807

3260

3714

4167

4

1021

1474

1928

2381

2835

3289

3742

4196

5

1049

1503

1956

2410

2863

3317

3770

4224

6

1077

1531

1984

2438

2892

3345

3799

4252

7

1106

1559

2013

2466

2920

3374

3827

4281

8

1134

1588

2041

2495

2948

3402

3856

4309

9

1162

1616

2070

2523

2977

3430

3884

4337

10

1191

1644

2098

2551

3005

3459

3912

4366

11

1219

1673

2126

2580

3033

3487

3941

4394

12

1247

1701

2155

2608

3062

3515

3969

4423

13

1276

1729

2183

2637

3090

3544

3997

4451

14

1304

1758

2211

2665

3118

3572

4026

4479

15

1332

1786

2240

2693

3147

3600

4054

4508

Measurements

Other measurements are also taken of each baby. These include the following:

Breathing rate (normally 40 to 60 breaths per minute in the newborn period

Physical exam

A complete physical exam is an important part of newborn care. Each body system is carefully examined for signs of health and normal function. The doctor also looks for any signs of illness or birth defects. Physical exam of a newborn often includes the assessment of the following:

General appearance. Physical activity, tone, posture, and level of consciousness

Skin. Color, texture, nails, presence of rashes

Head and neck:

Appearance, shape, presence of molding (shaping of the head from passage through the birth canal

Fontanels (the open "soft spots" between the bones of the baby's skull

Clavicles (bones across the upper chest

Face. eyes, ears, nose, cheeks.

Mouth. palate, tongue, throat.

Lungs. Breath sounds, breathing pattern.

Heart sounds and femoral (in the groin) pulses.

Abdomen. Presence of masses or hernias.

Genitals and anus. For open passage of urine and stool

Arms and legs. Movement and development.

Gestational assessment

Assessing a baby's physical maturity is an important part of care. Maturity assessment is helpful in meeting a baby's needs if the dates of a pregnancy are uncertain. For example, a very small baby may actually be more mature than it appears by size, and may need different care than a premature baby.

An examination called The Dubowitz/Ballard Examination for Gestational Age is often used. A baby's gestational age often can be closely estimated using this examination. The Dubowitz/Ballard Examination evaluates a baby's appearance, skin texture, motor function, and reflexes. The physical maturity part of the examination is done in the first two hours of birth. The neuromuscular maturity examination is completed within 24 hours after delivery. Information often used to help estimate babies' physical and neuromuscular maturity are shown below.

Physical maturity

The physical assessment part of the Dubowitz/Ballard Examination looks at physical characteristics that look different at different stages of a baby's gestational maturity. Babies who are physically mature usually have higher scores than premature babies.

Points are given for each area of assessment, with a low of -1 or -2 for extreme immaturity to as much as 4 or 5 for postmaturity. Areas of assessment include the following:

Skin textures (for example, sticky, smooth, or peeling).

Lanugo (the soft downy hair on a baby's body). Absent in immature babies, then appears with maturity, and then disappears again with postmaturity.

Plantar creases. These creases on the soles of the feet range from absent to covering the entire foot, depending on the maturity.

Breast. The thickness and size of breast tissue and areola (the darkened ring around each nipple) are assessed.

Eyes and ears. Eyes fused or open and amount of cartilage and stiffness of the ear tissue.

Genitals, male. Presence of testes and appearance of scrotum, from smooth to wrinkled.

Genitals, female. Appearance and size of the clitoris and the labia.

Neuromuscular maturity

Six evaluations of the baby's neuromuscular system are done.

A score is assigned to each assessment area. Typically, the more neurologically mature the baby, the higher the score. The areas of assessment include:

Posture. How does the baby hold his or her arms and legs.

Square window. How far the baby's hands can be flexed toward the wrist.

Arm recoil. How much the baby's arms "spring back" to a flexed position.

Popliteal angle. How far the baby's knees extend.

Scarf sign. How far the elbows can be moved across the baby's chest.

Heel to ear. How close the baby's feet can be moved to the ears.

When the physical assessment score and the neuromuscular score are added together, the gestational age can be estimated. Scores range from very low for immature babies (less than 26 to 28 weeks) to very high scores for mature and postmature babies.

All of these exams are important ways to learn about your baby's well-being at birth. By identifying any problems, your baby's doctor can plan the best possible care.